背景:重要的是探索减少SB核数量的策略,以最大程度地减少活检相关的发病率和活检期间患者的不适。这项研究旨在通过减少系统活检(SB)核心的数量来优化前列腺活检程序,同时在联合活检时代保留癌症检出率。
方法:我们前瞻性招募了磁共振成像(MRI)病变≥1的患者,他们接受了经会阴联合12核SB3核靶向前列腺活检(TB,参考标准)。新策略被定义为横向6核心SB+3核心TB。患者作为自己的对照。在标准SB中比较了整体前列腺癌(PCa)和临床意义PCa(csPCa)的检出率,MRI-TB,6核SB+3核TB,和参考标准。使用Kappa检验评估病理学一致性。
结果:共包括204名男性,其中111例(54.41%)和92例(45.10%)含有整体PCa和csPCa。与仅进行SB或3核TB相比,经引用的联合活检检测到CSPCa的显着增加6.86%(P=.0005)或4.90%(P=.0044),但与新的活检策略相当.(45.10%与43.14%,P=.1336)当限制活检初治男性患者或通过前列腺成像报告和数据系统评分分层时,类似的结果仍然存在,PSAD,和指标病变参数。此外,进行6-核心SB+3-核心TB在等级组分布方面表现出与参考标准的高度一致性(Kappa系数:0.952,对于活检-幼稚男性为0.961),并获得了95.7%(全部:95%CI:89.2%-99.8%)和96.9%(活检-幼稚:95%CI:91.1%-99.7%)的优越敏感度,分别。
结论:6核心SB+3核心TB方法保持了预期的检出率,同时减少了总核心计数,提供了一个有希望的替代参考标准,这可能有助于定制经会阴联合活检程序。
BACKGROUND: It is important to explore strategies reducing the number of SB cores taken to minimize biopsy-related morbidity and patient\'s discomfort during biopsy. This study aims to optimize prostate biopsy procedures by reducing the number of systematic biopsy (SB) cores while preserving cancer detection rates in the era of combined biopsy.
METHODS: We prospectively recruited patients with ≥1 magnetic resonance imaging (MRI) lesions and they underwent transperineal combined 12-core SB+3-core targeted prostate biopsy (TB, reference standard). New strategy was defined as a laterally 6-core SB+3-core TB. Patients were served as their own control. Detection rates for overall prostate cancer (PCa) and clinically significant PCa (csPCa) were compared among the standard SB, MRI-TB, 6-core SB +3-core TB, and reference standard. Pathology consistency was assessed using the Kappa test.
RESULTS: A total of 204 men were included, of which 111 (54.41%) and 92 (45.10%) harbored overall PCa and csPCa. Referenced combined biopsy detected significantly 6.86% (P = .0005) or 4.90% (P = .0044) more csPCa than performing only SB or 3-core TB, but was comparable to the new biopsy strategy. (45.10% vs. 43.14%, P = .1336) Similar results persisted when limiting patients in biopsy-naïve men or stratified by Prostate Imaging Reporting and Data System scores, PSAD, and index lesion parameters. Additionally, performing 6-core SB+3-core TB demonstrated high consistency with reference standard in grade group distribution (Kappa coefficient: 0.952 for all, 0.961 for biopsy-naïve men) and achieved superior sensitivity of 95.7% (All: 95% CI: 89.2%-99.8%) and 96.9% (Biopsy-naïve: 95% CI: 91.1%-99.7%), respectively.
CONCLUSIONS: The 6-core SB+3-core TB approach maintains expected detection rates while reducing the total core count, offering a promising alternative to the reference standard, which may help to tailor transperineal combined biopsy procedures.